A Disturbing Trend

The old ladies of therapy have been talking again. This time we were discussing a trend we've noticed. We're concerned because what we've seen doesn't bode well for the future of our profession. None of us are excited with the new graduates we've been coming across. They don't impress us. They don't have the same commitment to the profession as those of our generation. They lack skills. Each of us old ladies had an experience of leading a new graduate by the hand through something because the grad didn't know what to do. These are the up and coming therapists who are supposed to lead us toward Vision 2020 and beyond. I expect better.

Now I'm not saying this is true of everyone who has graduated in the last few years. I've met some wonderful new and recent graduates. I've met some who have knowledge and skill beyond their experience. I've also met the opposite. I've lost count of the students who tell me they only want to do orthopedic outpatient. I can't count the times I've heard someone refuse to do something with the excuse of being the therapist. Worse, I've met several recent graduates who look down on us old gals because we do things "the old way." Does it matter how old the technique is as long as it is effective? Robin McKenzie developed his system over 40 years ago. It has proven to be effective over and over again. By that logic we should throw it out because it is an old therapy.

I'm not sure where the problem comes from. I've talked to professors. I'm taking courses. I don't' think the schools are teaching this. The attitude may be an unexpected byproduct of the learning process. I don't' think it is deliberate. Maybe the selection process inadvertently weeds in these individuals. Us old gals think it has something to do with the generation of individuals entering schools. We've noticed an attitude of expectation. Back in the day when I was in school I hoped I would find a job. I hoped I would make a decent salary. I worked as hard as I could so I could keep my scholarships to stay in school.

This last week I came across two prime examples of this behavior. One recent grad boasted how she could handle anything because she worked for 8 months rotating between several units in a hospital. I doubt that. She had trouble keeping her left neglect patient from walking in a circle right before she said that. I know that place she worked. It was good experience but nowhere near all encompassing.

The second example was a therapist who doesn't want to be a therapist. He made it a point to tell me he didn't like being a therapist. His real job was selling a medical product. So, I wanted to ask, why did you waste all that time in PT school? I would have except I had to walk away before I said something really not nice.

What concerns me is the lack of respect for the profession I see in this. Physical therapy doesn't need individuals who settle for mediocre because it is easy to accomplish. We need individuals who are pushing the envelope for every patient. If I take my horse to the vet I want a vet who not only knows what he is doing but is learning more and willing to stay with my horse as long as it takes. Horses are fragile. So are people. I want my loved one to have the best care possible which to me means someone who knows what to do, how to do it and doesn't mind if it isn't easy.

I know lots of experienced therapists who just get by. That isn't age specific. What is age specific is the apparent lack of knowledge and skills. Maybe I'm totally wrong. Maybe what we're seeing is uncertainty or fear of being wrong. As I initially said, it isn't every one. Us old gals were just talking. We're old. We could be confused. I hope we happened to pick up on the outliers rather than the trend.

10 comments

I have seen all of this and I do not think it is just a PT new grad or DPT issue. What I have observed is that it is generational. The 20-30 somthings of today are about "me" They want $$$, lots of time off, a schedule that works around all the other things that are important to them etc. Most of the new grad DPTs I have interacted with generally have never had any job at all, never worked a day in their life as a employee etc.

Russell PT

July 16, 2008 11:01 AM

You are not alone in observing these issues. I was a student clinical educator for years and have noticed the decline in students' knowledge and skills upon leaving PT schools. I also have a good friend who is an Orthopedic physician and she is noticing the same problems with med students. They try to tell her what hours they will be working and what activities they will participate in. There are several possible reasons for these problems we are seeing. #1) The pool of students applying to PT schools is shrinking yet the schools want to fill their seats, #2) The cost of getting a PT degree is insane anymore! Is it driving many potential PT students away? #3) Are the DPT students lead into believing that they are much smarter than us "oldies" because of their degree? #4) Are they getting enough clinical time or are they stuck in a classroom more due to the requirements of the DPT degree? I have noticed in the curriculum of several DPT schools that the students are required to do research projects. Leave the research to those who want a career in that. Right now they need clinical experience! #5) Are they being taught to "over complicate" PT care and skills? Is this why they think our old yet reliant practices seem archaic?

I know that not every student fits into this pool but it seems distressing when there are a lot of us "oldies" noticing these same issues. I personally have not been able to accept a PT student for a couple of years because their clinicals have become much more time consuming due to their lack of clinical knowledge and at times lack of motivation.

Thanks for the information and honesty!

Kristi J.,PT, SNF's - Rehab Director

June 13, 2008 2:27 PM

SD

I understand everyone's point of view as I was transitioned into a DPT from a MSPT program. The DPT was made too easy to obtain not to pursue it.

I feel there are many bigger issues in the world of PT than badmouthing a handful of new generation PTs. One major issue being the APTA and DPT-offering universities/colleges are forgetting (or rather completely realizing) the cost of going to school for the DPT for someone just out of high school. When I am asked by local persons or other health care providers about his or her child wanting to go into PT I stop them immediately. My first question is, "Are you going to be assisting your child with paying for their DPT/grad school?" If they say probably not I tell them to dissuade their kid from going to PT school. It costs way too much money, even at state schools, to obtain the DPT. New PTs (with DPTs) are incurring a massive amount of educational debt they can't afford to pay back. PT salaries are not that great, regardless of what people think. Topping out at 70-80K just doesn't cut it. PharmDs are coming out of school making 120-125K! OTs are coming out with MAs making only 4-5K less than us.

The ever shrinking health care pockets of the US and consumer have made it harder to get reimbursement regardless of what area you practice in. With a recession looming, I'm sure people will forgo O/P services at clip of 10-100/week in co-pay costs and feed their families.

I love helping the children and families I work with, but as a single person, PT just doesn't make the grade. That being said, I have already begun applying for medical device and pharma jobs. My guess is the trend to get out of PT will continue as many of my colleagues have already done the same. The DPT is not necessary! It brings no pay increase, respect, or anything. Just some harsh feelings from others in the field.

APTA....Vision 2020 needs to be overhauled for this profession to start to thrive again! I hope someone is listening!

John

June 10, 2008 8:53 PM

NJ

THANK YOU FOR WRITING THIS ARTICLE!!! We have noticed that many of the new grads that have started at our facility have had the I-AM-A-DPT-AND-I-KNOW-EVERYTHING-ALREADY syndrome you are talking about. Several have also had issue with the PTA's in our facility...treating us as aids, secretaries, etc because they did not learn how to use a PTA appropriately. Heaven forbid if you give a suggestion to one of these new grads reguarding patient care, documentation, etc as I am a LOWELY PTA with only 10 years of experience. Thank you for shedding light on this situation.

Janelle, acute - PTA, CCMH

June 4, 2008 12:42 PM

GilletteWY

I have been licensed as a PTA for 25 +++ yrs, and I do not think these MPTs or DPTs have anything on the PT's who have their bachelors degree. They are happy to be PTs, do not need this MPT or DPT following their name,the latter being the worse and eventually the joke of the profession, I thing it stands for dufus, dimwit ect..

Bobbie Abbott, Adults/Peds - PTA, OP/homehealth

June 3, 2008 6:26 PM

GainesvilleFL

I would tend to agree with some of the statements posted. The new therapists coming out are of the "me" generation, and wanting instant gratification. They are wanting constant praise and become disenchanted when things don't occur quickly. But isn't our job as professionals to mentor these individuals that will become the upcoming profession? I mean most of the new grads are very young. I mean went from high school, straight to under grad, and then grad school. May have never held a job before this one. The previous generations should accept this as a challenge, just as we do our patients, and make sure we are still seen as the caring and compassionate healthcare "professional", well versed in our skills, and willing to encourage and embrace growth amongst us all.

Leah, Outpatient rehab - Staff Physical Therapist, Riverside Rehab

June 3, 2008 11:39 AM

I see a merging of the poor attitudes described by the author, a sense of entitlement (example: call me a doctor because I am a DPT), the escalation of salaries and the occasional poor dedication to patient care will merge into one point in time. Where the end result is PT’s will price themselves out of the market and there value is called into question. The idea that physical therapy (to use a general term) can only be done by a Physical Therapist will be (more) questionable in the future. Yes there may be piles of research that shows the benefit of PT, However, there is only so much money in healthcare, and the money is running out.

Paul

May 23, 2008 10:56 AM

Physical therapy is a service profession. The ideal therapist must fit a certain personality first, be complemented by an array of necessary technical skills, and fully rounded by years and years of experience. So whenever a newly graduated PT claims that he or she knows it all, he or she is either just naive or plainly mistaken. However, a therapist with decades of experience should be mature and secure enough to accept that there will always be advances in the techniques that we use, something new PT's already have, and should be willing to keep up with the times.

No PT can truly say that he or she is better than another PT, and we should not be too concerned about this issue because in the end it all boils down to the simplest of things like a faint smile from a patient who just took his first step after an injury. This is the force that should keep us, young and old, going in this profession.

Oce, PT

May 21, 2008 4:14 PM

RockleighNJ

Although your recent experiences are disturbing, I disagree with you that "what is age specific is the apparent lack of knowledge and skills." I also know "lots of experienced therapists who just get by" and also lack knowledge and skills!!

I would like to suggest that what you have experienced is more of a lack of professional behaviors by these new graduates that you shared your story about. If you look at any States disciplinary actions you will see that close to 90% of actions are due to poor judgement in use or non-use of professional behaviors on the part of the professional. If you are able to deliniate the year the professional received their licensure based on the license numbers, you would see that lack of professional behaviors is not limited to the new graduate.

The APTA has developed a great tool for self assessment titled "Professionalism in Physical Therapy: Core Values. Every professional should evaluate and self-reflect on their behaviors from time to time. Thank you for your post.

Laurie

May 21, 2008 12:03 AM

This new generation is definitely a "me" generation. They want to leave at 4:59 and won't start until 9:01. It doesn't matter if someone calls in sick or there are patients who still need to be seen...they want to make sure their needs are taken care of first!

It makes you wonder what's going to happen when us old ladies need therapy and these youngsters are the ones who will provide it!!

Joan, Physical Therapist

May 20, 2008 6:20 PM

Portland OR

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